Clinical practice guidelines on renal cell carcinoma were updated in October 2022 by the European Association of Urology (EAU) Renal Cell Carcinoma (RCC) Guideline Panel in European Urology. 
Contrast-enhanced, multiphase chest and abdomen CT should be used for renal tumor diagnosis and staging.
However, imaging without ionizing radiation, such as MRI and contrast-enhanced ultrasound, should be used to investigate small renal masses, tumor thrombi, and for differentiation of CT results, if necessary.
Renal tumor biopsy with coaxial technique should be performed before the initiation of ablative or systemic therapy if no previous pathology exists.
Cystic renal masses should not be biopsied unless a significant solid component appears on imaging.
Patients with localized RCC should be offered curative surgery.
Patients with T1 tumors should be offered partial nephrectomy. Radical nephrectomy, even via a minimally invasive approach, should not be offered to these patients if open or minimally invasive partial nephrectomy is feasible.
In the absence of evidence of adrenal gland invasion, ipsilateral adrenalectomy should not be undertaken.
Laparoscopic radical nephrectomy should be offered to patients with T2 tumors or with local masses not amenable to partial nephrectomy.
Biopsy of a renal mass should be performed before thermal ablation rather than concomitantly with thermal ablation.
In non-metastatic disease, the renal tumor and thrombus should be excised if there is venous involvement.
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Cite this: Renal Cell Carcinoma Clinical Practice Guidelines (EAU, 2022) - Medscape - Nov 01, 2022.